Humana Medicaid Quality Improvement Consultant in United States

Role: Medicaid Quality Improvement Consultant Assignment: Healthcare Quality Reporting and Improvement Location: Louisville, KY – Humana Tower Assignment Capsule As a Medicaid Quality Improvement Consultant, you will work directly with internal customers to help guide Humana’s decision makers (executives to front-line leaders) to maximize quality effectiveness, enhance quality of care, and minimize waste and variability within the healthcare delivery system using your consulting, analytics and problem solving skills. In this role, you will have a direct impact on maximizing the excellence of care that Humana’s members receive and, in turn, the financial benefit that Humana receives by achieving high performance. Role responsibilities to include: * Assess and influence Humana’s Medicaid healthcare quality operations strategies and tactics using in-depth analytics and knowledge of healthcare industry best practices and new innovations

  • Build effective relationships with all business partners and stakeholders.

  • Work closely with partners in the Healthcare Quality, Reporting, and Improvement organization, the Medicaid markets, and throughout the enterprise to understand the specific needs of those partners and organizations and develop risk adjustment and quality initiatives that deliver the right behavior and interventions for our members and providers.

  • Develop subject matter expertise in the latest quality improvement and risk adjustment methods for Humana’s Medicaid programs and serve as a consulting resource for the needs of partners across the enterprise.

  • Examine and communicate trends to senior leaders regarding opportunities to improve outcomes in quality and risk adjustment.

    Role Essentials

  • Bachelor’s Degree in Engineering, Public Health, Operations, Healthcare Administration, Economics or other healthcare related field

  • 2 years' healthcare experience with a proven ability to make independent decisions that drive business results

  • Strong understanding of healthcare policy developments; such as the Affordable Care Act, Medicaid and/or Medicare

  • Comfortable defining own work priorities and timelines with limited supervision

  • Excellent PC skills (including MS Office Suite)

  • Ability to exercise independent judgement with minimal direction many times under ambiguous circumstances

  • Strong written and verbal communication. Strong problem solving and reasoning skills.

  • Ability to work in a matrix management environment

  • Ability to process complex concepts and deliver in an easy to understand format Desirables

  • Interest and ability to define and pursue understanding of a customer’s business obstacles to success and the ability to make clear solution recommendations

  • A strong desire to serve Humana’s underserved and vulnerable membership

  • General understanding of Risk Adjustment, specifically CDPS Rx

  • Exposure to established industry standards for measuring healthcare quality: HEDIS, CAHPS, HOS, and other quality metrics

  • Prior analytical experience with Medicaid and/or other healthcare data (SQL experience is a plus) Reporting Relationships

  • You will report to a Strategic Consultant. This area is under the leadership of the SVP Healthcare Quality and Reporting and Improvement.

Title: Medicaid Quality Improvement Consultant

Location: US

Other Locations: US-KY-Louisville

Requisition ID: 190387

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.